Nursing cooperation related to thoracoscopic surgery in children

Hong-Xu Ren, Si-Qin Wang, Shuang-Shuang Liu, Yong-Chao He, Xiao-Yu Liu

1The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China. 2Xianshuigu Township Health Center, Tianjin 300350, China. 3The Affiliated Children’s Hospital of Shandong University, Jinan 250022, China.

Abstract Objective: To explore the nursing cooperation of pediatric cardiac surgery by thoracoscopy.Methods: 30 patients undergoing thoracoscopy in a third‐grade hospital in Yantai were observed and their nursing process was recorded and analyzed. Results: The good cooperation of operating room nurses and equipment nurses can relax the children and increase the success rate of surgery and reduce the occurrence of complications.Conclusion: Full preoperative preparation, close intraoperative cooperation, strict instrument maintenance, and cleaning and disinfection are the guarantee of pediatric thoracic surgery.

Keywords: thoracoscopy; pediatric cardiac surgery; perioperative nursing

Introduction

Thoracoscopic surgery technology is constantly mature and has been gradually applied in pediatric thoracic surgery diseases.Thoracoscopic surgery has gradually begun to be applied because it has a better vision. However, because thoracoscopic technology is relatively advanced, there is a lot to pay attention to in nursing [1].From January 2020 to December 2021,30 cases of pediatric thoracic surgery disease TV thoracoscopic surgery (VATS) were performed in the hospital. The results were satisfactory, which is reported as follows.

Clinical Data and Methods

Clinical Data

Thirty pediatric patients with thoracoscopic surgery were selected from January 1, 2020, to January 01, 2021, in a Grade A hospital in Yantai City. Of the 30 children, 22 were male and 8 were female, aged 4–11 years (7 ± 3.14 years). Bodyweight was 6 to 22 kg, with an average of 14.6 kg. The ventricular septal defect (VSD) occurred in 14 patients (8 combined with severe pulmonary hypertension), 15 with atrial septal defect (ASD), and 1 with ventricular septal defect combined with the atrial septal defect. All patient families gave informed consent to the study and signed an informed consent form to voluntarily participate in the study process. Ethical approval was obtained from the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Number [2021]620.

Surgical method

Thoracoscopic cardiac surgery is to make three holes with the size of 1–2 cm in the left chest wall, and then insert incision protective sleeve, thoracoscope, and corresponding operating instruments. A 2 cm incision was made in the right groin area of the patient, and the femoral artery and vein were freed respectively, and cardiopulmonary bypass was established by intubation through the femoral artery and vein. Then, cardiac surgery and intracardiac operation were completed with the help of TV image system monitoring.

Statistical Methods

SPSS 22.0 statistical software was used to process the data. Counting data were expressed as percentages and analyzed by χ2test;measurement data were expressed as χˉ ± s witht‐test. The difference is statistically significant withP＜ 0.05.

Results

General anesthesia downward intracardiac surgery and extracorporeal circulation treatment of congenital malformations were recovered and discharged. Of the 30 patients, 2 patients had surgery‐related complications. After active treatment and careful care, they finally recovered and were discharged, with an average hospital stay of 34 days (Table 1).

Nursing cooperation

Preoperative preparation Preoperative visit

Because children often to the result of the operation, their condition concerns and anxiety, so 1 day before the operation to the children ward nursing staff to visit, understand, the family situation, visiting children's condition, at the same time, and extract relevant examination data, to understand the condition and operation. Nurses can contact children through body language, such as touching, with a smile, to reduce their fear of nurses, patiently explain preoperative and preoperative cooperation; answer parents 'concerns, reduce parents' anxiety about surgery [2].

Environment and special items

Children's body temperature regulation is not perfect, the body surface area is relatively large, we should pay attention to keep warm. The body temperature of the operating room is generally set at 24 to 26 °C.Maintain the auxiliary temperature of the operating bed to protect important organs (e. g., heart, brain and kidney) during the operation[3]. Prepare CPR items, such as a special cardiac defibrillation plate for children, special pacing wires for children, special negative electrode plate for children, warming blankets, special surgical magnifying glass and various special equipment and sutures [4].

Interoperative cooperation Cooperation of operating room nurses

The previous visit was conducted by the operating room nurses, and when the patients entered the operating room, they were also received, accompanied and cared for by the operating room nurses.Because the children are already familiar with nurses, the children in the operation can cooperate effectively [5].

Complete anesthesia with the anesthesiologist

To avoid cyanosis and hypoxia in the operating room crying, the nurse and the anesthesia accompanied by family members to access the pediatric basic anesthesia and intravenous needle puncture upper limb surgery, establish intravenous channels, 30 min preoperative intravenous antibiotics to prevent infection, and adjust the infusion speed; when the patient enters the operating room, quickly establish intravenous channel puncture, radial artery puncture after anesthesia intubation, carotid puncture anesthesia, which can reduce pain [6].

Surgical body position

Assist the anesthesiologist and position the children after general anesthesia. The surgical position was placed as required. Routine supine position, both upper limbs extension 80 to 90 degrees fixed on the support plate; mediastinal surgery, exposed to circular cartilage ring and neck pads; when properly fixed pipes, fully exposed surgical vision. Children's skin is delicate, pay attention to move gently, do not drag. Pay attention to keep warm, with a soft cloth will be children with both hands and forearms, feet and legs wrapped, easy to maintain the body temperature, the tightness of the package should be appropriate. Be sure to straighten the child's sheets and keep them smooth and dry. Paste the bipolar plate on the child's hip, because the hip muscles are rich, you can fully contact the skin, avoid contact with metal objects, and prevent electrical burns. The body on both sides are padded with 2 cotton pads, used to absorb excess disinfectant, to avoid skin burns. Correctly connected camera system, thoracoscopic lens, optical guide fiber, electrocoagulation, ultrasonic knife, water absorber and computer transmission system, adjust the brightness and clarity, select the appropriate electrocoagulation power, display on the left side of the head, the host placed behind the surgeon of the ultrasonic knife; straighten the wire, avoid the twisted work; assist the doctor to disinfect the towel connection equipment, and adjust the parameters [7].

Table 1 Surgery-related complications and average hospitalization day of the children (n, χˉ ± s)

Temperature regulation

The surgery is a long time and the temperature requirements are strict.The operation is through heat preservation, cooling and rewarming.The first stage is to keep warm with a warm blanket to fill blood vessels and perform arteriovenous puncture. The second stage was cooling, and at the beginning of the extracorporeal cycle, the nurse quickly closed the warming blanket and lowered the room temperature to 18 °C with an anal temperature of 25 to 30 °C. The third stage is rewarming, after the completion of the cardiac surgery,using the body surface complex and gentle cardiopulmonary bypass rewarming. Before the heart beats, the anal temperature rises to about 32 °C, and then it rises to 35 °C. Generally speaking, according to the slow surgical process, to avoid the rapid cooling caused by microcirculation disorders, insufficient tissue perfusion, to make the blood oxygen saturation decreased.

Record the access volume

Monitoring indicators were observed after surgery. Generally, the intake of various liquids, such as crystal, colloid, blood, urine volume,and blood volume, were recorded respectively. The amount of urine and bleeding must be measured accurately, timely reported to the anesthesiologist, perfused ator and recorded. After the start of the extracorporeal cycle, various fluids are turned off. After the extracorporeal cycle, peripheral intravenous infusion is used, and the input is adjusted according to the situation. During the operation,closely observe breathing, blood pressure, blood rate and blood oxygen saturation, blood circulation and abduction of children with the upper limbs, keep warm, do not remind doctors to put pressure on children such as heavy equipment, to avoid limb pressure. Closely observe the operation process, and timely replenish the required equipment and goods [8].

Cooperation with equipment nurses

Equipment nurses should wash their hands 30 minutes in advance and arrange for surgical instruments. Check whether the project is complete and correct, if any omission, should be supplemented immediately. Check the performance model and accessories of the thoracoscopic device at 20 min in advance. For smaller devices,strictly check whether they are loose to prevent the parts from entering the body cavity and remaining in the patient's body. Connect it with the operating room nurse to adjust the focal length of the camera by use order, and count the inventory of equipment, gauze,dressing, disinfection and cooperate with the doctor.

Transfer of the children

Children need special transfer beds. At the end of the operation, the children's special bed was pushed to the operating room 30 minutes in advance to supply power and preheat. The transit kept the pipeline unobstructed and transferred.

Discussion

Pay great attention to psychological care

Because thoracoscopic surgery is a new type of operation, patients have more psychological anxiety and worry about the success of the operation. Nurses should communicate with the patients in bed one day before the surgery, emphasize the advantages of cosmetic laparoscopic surgery, small trauma, fast recovery and early discharge,and introduce successful cases. And compared with traditional surgery, let the patients undergoing surgical treatment relax.

Pay attention to the disinfection and maintenance of endoscopic instruments

According to the Ministry of Health issued "endoscopic cleaning disinfection technical specification (2004 version)", in strict accordance with the four washing, enzyme washing, cleaning and drying steps, removable parts must be removed after cleaning, a small part wrapped in gauze, cleaning in flowing water, soft cleaning device cavity, washing must see both brushes, with 1:200 enzyme detergent 10min, then clean pipe with water gun, dry gauze dry dryer cavity and shaft section moisture, and then wipe clean, dry plate, no discount.

Circle diameter shall be greater than 15 cm, statistical tools and widgets, spare parts package. The endoscope equipment was autoclaved steam and the wires were sterilized using a hydrogen peroxide plasma cryogenic sterilizer.

Patient vital signs were closely observed during the operation

For better exposure to the surgical field, single lung ventilation is selectively used during the operation, the right lung lobe collapses, if the oxygen saturation drops sharply during the operation, the operating room nurse should remind the anesthesiologist to repair the double lung ventilation immediately. Due to the change of temperature, the lens is easy to produce fine water mist inside and outside. The nurse should wipe with iodine cotton in time to keep the surgical field clear.

Operating room nurses should cooperate closely with the anesthesia and cardiopulmonary bypass division

Cardiac surgery to use more blood and drugs, the nurse should strictly check and sign, generally do not perform oral medical advice, must be performed after repeated examination and check with the anesthesiologist. The anticoagulant heparin and protamine that neutralize heparin were prepared before surgery.

Pay attention to the ambient temperature regulation

Heart surgery requires high ambient temperature because of preoperative dynamics and intravenous puncture exposure, and operating room nurses should adjust at room temperature. During in vitro circulation, room temperature can reduce myocardial oxygen consumption and increase room temperature during rewarming.

Summary

Video‐assisted thoracoscopy has been widely used in the diagnosis and treatment of thoracic surgery diseases due to its advantages of small trauma and clear vision [9]. Children's thoracic surgery, the incision is also very small, the surgical field can not be fully exposed, is not conducive to the operation of the thoracoscopic lighting system,thoracoscopic surgery can fully expose the surgical field of vision through this hole, the operation is a small damage, less bleeding. Short use time can reduce postoperative complications, such as incision pain, and can gradually be applied to pediatric thoracic surgical diseases [10]. To ensure the smooth operation, the nurse master the steps, connection methods and matters needing attention, master the simple troubleshooting method, and does video work according to the monitoring screen display control; children can be adjusted according to the operating bed to facilitate surgical operation. Device nurses must be familiar with the thoracoscopic surgical procedures, the surgical instruments required at each stage, listen carefully to the doctors to discuss various projects, timely supplement, skilled and accurate various equipment and materials. After the operation, after the thorough cleaning and maintenance and disinfection of the used equipment, the camera must have a protective cover, pay attention to each mirror protection of the optical mirror, electronic mirror, to prevent fall damage and sharp scratches, etc. The thoracic surgery system is a set of advanced medical equipment, sophisticated and fragile, so there should be a special care custody method for regular inspection [11]. In short, full preoperative preparation, close intraoperative cooperation, strict instrument maintenance and cleaning and disinfection are the guarantee of the smooth progress of pediatric thoracic surgery.